Washington County Nursing Home

Inspectors wroteBased on record review and interviews the facility failed to ensure one (#1) of three residents received treatment and care in accordance with professional standards of practice out of three sample residents. Specifically, the facility failed to ensure Monitor Resident #1's blood sugar after long acting insulin was administered to ensure the effectiveness of the medication.

Inspectors wroteBased on observations and staff interviews, the facility failed to maintain an infection control and prevention program designed to provide a sanitary environment to help prevent the development and transmission of communicable diseases and infections. Specifically, the facility failed to follow proper infection control practices during insulin injection via insulin pen by using Resident #3 insulin pen to inject insulin to Resident #1.

Inspectors wroteBased on record review and staff interviews, the facility failed to develop and implement a comprehensive care plan for three (#38, #24 and #3) of five residents reviewed for care plans out of 19 total sample residents. Specifically, the facility failed to: -Ensure Resident #38 had a care plan for the use of an anticoagulant medication; -Ensure Resident #24 had a care plan for the use of supplemental oxygen; and, -Ensure Resident #3 had a care plan for the use of a diuretic medication.

Inspectors wroteBased on interviews, observations and record review, the facility failed to promote care for residents in a manner and in an environment that maintained or enhanced their dignity and respect for one (#35) of three residents reviewed for dignity out of 19 sample residents. Specifically, the facility failed to ensure Resident #35's fall intervention sensor alarm was discussed with the resident on how it made her feel.

Inspectors wroteBased on record review and interviews, the facility failed to ensure drug regimens were free from unnecessary medications for one (#38) of five residents reviewed for unnecessary medications out of 19 sample residents. Specifically, the facility failed to ensure Resident #38 was adequately monitored and side effects were documented for the use of an anticoagulant medication.

Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the possible development and transmission of infectious diseases. Specifically, the facility failed to ensure nursing staff followed proper infection control procedures for a resident on enhanced barrier precautions (EBP).

Inspectors wroteBased on observations, record review and interviews, the facility failed to implement appropriate nutritional interventions for one (#26) out of 20 sample residents to maintain acceptable parameters of nutritional status. Resident #26, age [AGE], was admitted to the facility on [DATE] with diagnoses of heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, history of falling and anxiety. Resident #26 sustained a weight loss of 10.6% (20.5 lbs) from admission on [DATE] through 1/31/23, which was considered significant. According to Resident #26's nutrition care plan, pertinent interventions initiated 3/4/23 included to monitor, record and report to the physician as needed any signs and symptoms of malnutrition such as significant weight loss and obtain and monitor lab/diagnostic work as ordered. [...]

Inspectors wroteBased on observation, records review and interviews, the facility failed to adequately monitor the resident for unnecessary psychotropic medications needed to provide effective and person-centered care for one (#19) of five residents reviewed for use of psychotropic medication out of 20 sample residents. Specifically, the facility failed to for Resident #19: -Ensure staff monitored the resident for effectiveness of antidepressant medication therapy since the resident was prescribed two antidepressant medications with one being used for a diagnosis of insomnia; -Ensure staff identified depressive target behaviors; -Ensure staff accurately monitored the resident for depressive target behaviors and hours of sleep for the antidepressant being used for insomnia; and, -Ensure staff monitored the resident for her response to antidepressant medication.

Inspectors wroteBased on record review and interviews, the facility failed to ensure individuals with a finding entered into the State nurse registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of property for one of five sampled staff members. Specifically, the facility failed to ensure residents were free from employee negligence by employing LPN #5 with a known history of negligence entered into the State nurse registry. Cross reference: F690 (Catheters), the facility failed to follow physician's orders for catheter placement resulting in harm to Resident #4.

Inspectors wroteII. The facility failed to ensure an RN assessment for injury was completed prior to moving a resident who had fallen A. Resident #36 1. Resident status Resident #36, age [AGE], was admitted on [DATE] and readmitted on [DATE]. According to the November 2019 computerized physician orders (CPO), the diagnoses included displaced fracture of base of neck of right femur, joint replacement surgery, dementia with behavioral disturbance and anxiety disorder. The 10/29/19 minimum data set (MDS) assessment revealed the resident had severe cognitive impairment with a brief interview for mental status score of three out of 15. She required extensive assistance of two people with bed mobility, dressing, toileting and personal hygiene. It indicated the resident had a fracture related to a fall prior to the resident's readmission to the facility and had hip replacement surgery. 2. [...]

Inspectors wroteBased on record review, interview, and review of facility policies, it was determined the facility failed to provide the appropriate care and services for one resident (#4) of one with a suprapubic catheter with a total sample of 26 residents. Specifically, the facility failed to: -Insert the indwelling catheter into the superpubic area, for Resident #4. The indwelling catheter was wrongly inserted into the penis meatus which resulted in bleeding, bruising and pain (Cross Reference F 606 failure to not employ staff with a history of negligence).

Inspectors wroteBased on record review and interviews; the facility failed to maintain acceptable parameters of nutritional status for one (#23) of two residents reviewed for nutrition out of 26 sample residents. Specifically, Resident #23, diagnosed with hypokalemia, anemia, hypocalcemia, gastro-esophageal reflux disease, and hyperlipidemia. On 5/3/19 the resident's weight was recorded at 143.0 lbs (pounds) and six months later on 10/16/19 the resident weighed 125.0 lbs. This was a 17.5 lbs significant weight loss, which was 12.24% over six months. On 9/3/19 the resident weighed 141.3 lbs and 18 days later on 9/21/19 the resident weighed 129.5 lbs. This was an 11.8 lbs significant weight loss, which was 7.8%. On 9/21/19 the resident weighed 129.5 lbs and 26 days later on 10/16/19 the resident weighed 125.0 lbs. This was a 4.5 lbs and 3.8% weight loss. [...]

Inspectors wroteBased on record review and interviews, the facility failed to develop and revise comprehensive care plans for each resident that included the instructions needed to provide effective and person-centered care for four (#36, #12, #10, and #18) out of 26 sample residents. Specifically, the facility failed to: -Ensure the care plan was revised and updated with fall interventions for Resident #36, #12, #10 and #18; -Ensure the care plan was revised and updated with Resident #10 current functional status, recent functional decline and newly developed pressure ulcers; and -Ensure the care plan was revised and updated following a suicidal ideation by Resident #10. [...]

Inspectors wroteBased on observation, interviews and record review the facility failed to ensure that two (#3 and #6) out of two residents reviewed for oxygen out of 26 total sampled residents received necessary respiratory care and services. Specifically, Resident #3 and #6 were administered oxygen; however, the facility failed to have a physician's order for the resident's oxygen.

Inspectors wroteBased on record review and interviews, the facility failed to ensure physician notification for two (#10 and #23) out of 26 sample residents. Specifically, the facility failed to ensure the physician was notified of Resident #10's change of condition and Resident #23's weight loss. Cross reference: F657 (Care Plan Timing and Revision), the facility failed to ensure the care plan reflected the current activities of daily living (ADL) status of Resident #10 following a recent decline.

Inspectors wroteBased on interviews and record review, the facility failed to ensure one (#88) of two out of 26 sample residents were kept free from abuse. Specifically, the facility failed to ensure Resident #88 was kept free from abuse from a staff member.

Inspectors wroteBased on interviews and record review, the facility failed to report an alleged violation of abuse to the State survey and certification agency for one (#88) out of two residents reviewed for abuse out of 26 sampled residents. Specifically, the facility failed to ensure an incident of physical abuse with Resident #88 by a staff member, which caused bruising and swelling to the resident's left forearm was reported immediately. Cross reference: F600 (Free from Abuse and Neglect), the facility failed to ensure Resident #88 was kept free from abuse from a staff member.

Inspectors wroteBased on record review and interviews the facility failed to develop a comprehensive care plan for two residents (#3 and #6) out of 26 residents reviewed of 26 residents sampled. Specifically the facility failed to: - develop a care plan the use of oxygen and a (anticoagulant) blood thinner for Resident #3 and, - develop a care plan for the use of oxygen for Resident #6.

Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure qualified staff persons in accordance with each resident's written plan of care provided care for one (#12) of three residents reviewed for accidents out of xx sample residents. Specifically, the facility failed to have a registered nurse (RN) assess Resident #12 following an unwitnessed fall.

Inspectors wroteBased on record review and interviews, the facility failed to ensure one (#10) of three out of 26 sampled residents received appropriate treatment and services to attain the highest practicable mental and psychosocial well-being. Specifically, the facility failed to assess Resident #10 following a suicidal ideation. Cross reference to F657 (Care Plan Timing and Revision) because the facility failed to ensure the care plan reflected Resident #10 suicidal ideation.